DIAGNOSTIC AND THERAPEUTIC ERCP IN PATIENTS WITH BILLROTH-II GASTRECTOMY

Diagnostic and therapeutic endoscopic cholangio- pancreatography (ERCP ) are more difficult in patients with Billroth II gastrectomy. A six-y ear experience including 274 ERCP in 175 Billroth II patients is revie wed. Overall diagnostic success-rate was 88.3% while a complete endosc opic treatment could be accomplished in 92.8% when indicated. Endoscop y related morbidity and mortality were 5.1% and 0 respectively, while in-hospital mortality was 2.3%. Diagnostic and therapeutic ERCP techni ques in Billroth II patients are then discussed with special reference to the choice of the scope and of the accessories to perform a safe e ndoscopic sphincterotomy. The use of the lateral-viewing duodenoscope and of the long-nose sigmoid inverted sphincterotome (originally modif ied by our group) are emphasized. ERCP and endoscopic sphincterotomy i n Billroth II subjects are today as safe and nearly as effective as in the non-gastrectomized patient.